Change in cardiovascular risk factors with progression of kidney disease.
BACKGROUND
Prior studies evaluating the relationship of kidney disease with cardiovascular risk factors have been limited by their cross-sectional design. We evaluated the change in lipids, inflammatory and procoagulant biomarkers with decline in kidney function in a nested case-cohort study in the Cardiovascular Health Study, a community-based study of adults aged >65 years.


METHODS
Individuals with an increase in serum creatinine >or=0.3 mg/dl (baseline to 3 years later, n = 207) were matched to controls of similar age, race, gender, diabetes and baseline serum creatinine, but whose change in creatinine was <0.3 mg/dl. Baseline and change in risk factors were analyzed with conditional logistic regression.


RESULTS
Changes in C-reactive protein were similar. In contrast, cases had larger increases in fibrinogen (OR 1.38 per standard deviation, 95% confidence interval 1.08-1.76) and factor VIII [1.38 (1.10-1.72)] and larger decreases in HDL [OR 0.80 (0.64, 1.00)]. Change in interleukin-6 was greater in cases than controls, but this did not persist after multivariate adjustment. However, in linear regression, change in interleukin-6 was correlated with change in creatinine.


CONCLUSIONS
Cardiovascular risk factors and kidney function may change concurrently. This could lead to an increased risk of cardiovascular disease as kidney function worsens.
Fried
Linda F
LF
Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pa. 15240, USA. linda.fried@va.gov
Katz
Ronit
R
Cushman
Mary
M
Sarnak
Mark
M
Shlipak
Michael G
MG
Kuller
Lewis
L
Newman
Anne B
AB
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology* / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000276:immunology; D012307:Risk Factors; D014657:Vasculitis / Q000453:epidemiology* / Q000276:immunology
D015415:Biomarkers; D008076:Cholesterol, HDL; C508600:IL6 protein, human; D015850:Interleukin-6; D005169:Factor VIII; D002097:C-Reactive Protein; D003404:Creatinine